BackgroundLifestyle counselling is a pivotal aspect of diabetes care. But general practitioners (GPs) often have problems in finding their role in patients’ weight management. The aims of this study were to investigate the experiences of type 2 diabetes patients with lifestyle counselling from their GPs and to explore how patients’ preferences regarding counselling are embedded in the context of self-management and wider cultural aspects of nutrition.MethodsNarrative interviews were conducted with 35 people with type 2 diabetes aged between 35 and 77 years. The interviews were transcribed verbatim and analysed using the thematic framework method.ResultsMany patients had a strong feeling of personal responsibility for weight reduction as integral to diabetes self-management but found it difficult to integrate the changes their disease requires into their self-management activities. They attached great importance to their GPs’ advice on diet. While some patients appreciated direct communication, others regarded dramatic pictures as either unhelpful or offending. A serious problem was the incompatibility of the dietary recommendations with daily life resulting in a reluctance to adjust the whole diet to the needs of diabetes care.ConclusionsAmbivalence towards patient self-management and tensions between the necessary changes to patients’ lifestyles and their culture, makes the GP’s role difficult and full of conflict. Instead of focusing exclusively on the guidelines of diabetes management and provision of information, GPs should explore the patients’ capabilities of self-management through open communication and accept their patients’ wishes to protect nutrition as part of their culture.

Background: Inappropriate prescriptions of Proton pump inhibitors (PPIs) initiated in hospitals are frequently continued in primary care. No research has explored why general practitioners (GPs) continue or discontinue inappropriate drug therapy. Objectives: This study aims to describe factors and motives associated with the continuation of inappropriate prescriptions of PPIs in primary care. Methods: Semi-structured qualitative interviews on basis of a purposive sampling of fi ve GPs who often continued inappropriate prescriptions and fi ve GPs who frequently discontinued inappropriate drug therapy with PPIs (10 GPs total, of which four were female and six male). Results: Although all GPs enrolled in the study were enthusiastic about the eff ectiveness of PPIs, diff erences between the continuing and discontinuing GPs exists in three areas: The two groups varied (1) in awareness of indications and general attitudes towards prescribing (2) in perception of the hospital physicians ' competence in prescribing and (3) appreciation of general prescribing conditions in hospitals. Conclusion:Diff erences between the continuing and discontinuing GPs were found in their level of knowledge and their perceptions of the hospital physicians ' competence and the threshold to prescribing in hospitals. Financial pressure and possible adverse eff ects demand a more balanced and evidence-based prescribing of PPIs. Attempts to change behaviour should focus on the GPs ' awareness of indications for PPIs, NSAID risks, and prescribing approaches in hospitals. Default prescribing in hospital demands critical examination.

In the case of non-specific neck pain, GPs often feel confronted with patients that demand dubious therapies and fail to consider psychological influences. The prescription of non-evidence-based therapies or referrals does not necessarily reflect a lack of knowledge but the GPs' strategic decision to improve the doctor-patient relationship.

ObjectivePeople with type 2 diabetes often report pressure to abstain from many of life's pleasures. We tried to reconstruct these patients’ sense of pressure to better understand how people with diabetes make sense of, and integrate, these feelings into their life.Design, setting and participantsA secondary analysis of narrative interviews with 14 patients with type 2 diabetes who are part of a website project.Main outcome measuresGrounded theory-based analysis of narrative interviews, consisting of open, axial and selective coding.ResultsPeople with type 2 diabetes felt obliged to give up many pleasures and live a life of abstinence. They perceived a pressure to display a modest culinary lifestyle via improved laboratory test results and weight. Their verbal efforts to reassure and distance themselves from excessiveness indicate a high moral pressure. With regard to the question of how to abstain, food and behaviour were classified into healthy and unhealthy. Personal rules sometimes led to surprising experiences of freedom.ConclusionsPeople with diabetes have internalised that their behaviour is a barrier to successful treatment. They experience an intensive pressure to show abstinence and feel misjudged when their efforts have no visible effect. Taking into account this moral pressure, and listening to patients’ personal efforts and strategies to establish healthy behaviours, might help to build a trusting relationship with healthcare providers.